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The present study investigated the impact of splenomegaly on the treatment outcomes of blunt splenic injury patients.All blunt splenic injury patients were enrolled between 2010 and 2018. The exclusion criteria were age less than 18 years, missing data, and splenectomy performed at another hospital. The patients were divided into two groups based on the presence of splenomegaly, defined as a spleen length over 9.76 cm on axial computed tomography. The primary outcome was the need for hemostatic interventions.A total of 535 patients were included. Patients with splenomegaly had more high-grade splenic injuries (p = 0.007). Hemostatic treatments (p 0.001) and transarterial embolization (p = 0.003) were more frequently required for patients with splenomegaly. Multivariate analysis showed that male sex (p = 0.023), more packed red blood cell transfusions (p = 0.001), splenomegaly (p = 0.019) and grade 3-5 splenic injury (p 0.001) were predictors of hemostatic treatment. The failure rate of transarterial embolization was not significantly different between the two groups (p = 0.180). The sensitivity and specificity for splenomegaly in predicting hemostatic procedures were 48.8% and 66.5%, respectively. The positive and negative predictive values were 62.8% and 52.9%, respectively. The overall mortality rate was 3.7%.Splenomegaly is an independent predictor for the requirement of hemostatic treatments in blunt splenic injury patients, especially transarterial embolization. Transarterial embolization is as effective for blunt splenic injury patients with splenomegaly as it is for those with a normal spleen.

Existing global navigation satellite systems (GNSSs) provide insufficient accuracy in terms of GNSS elevation and are limited by two-dimensional maps. Therefore, when traveling along a road that branches off to an overpass, it is impossible to immediately determine whether the vehicle is on the overpass. Inaccurate navigation not only causes anxiety for some drivers but also can lead to car accidents. This problem has existed since the invention of GNSSs. To the best of our knowledge, we are the first to conduct a large number of on-road experiments at different locations using off-the-shelf smartphones equipped with barometers. Based on the preliminary results of the wind tunnel and on-road experiments, we propose barometer-assisted road-layer detection (BARLD), which uses the changes in atmospheric pressure to determine the relative altitude. Comprehensive experiments in many different scenarios, including on overpasses, underpasses, and in parking lots, are discussed in this paper. The results confirm that the BARLD can effectively assist consumer-grade GNSSs to determine road layers. The source code of BARLD is publicly available, which would benefit the research community.

Uncontrolled post-traumatic hemorrhage is an important cause of traumatic mortality that can be avoided. This study intends to use machine learning (ML) to build an algorithm based on data collected from an electronic health record (EHR) system to predict the risk of delayed bleeding in trauma patients in the ICU. We enrolled patients with torso trauma in the surgical ICU. Demographic features, clinical presentations, and laboratory data were collected from EHR. The algorithm was designed to predict hemoglobin dropping 6 h before it happened and evaluated the performance with 10-fold cross-validation. We collected 2218 cases from 2008 to 2018 in a trauma center. There were 1036 (46.7%) patients with positive hemorrhage events during their ICU stay. Two machine learning algorithms were used to predict ongoing hemorrhage events. The logistic model tree (LMT) and the random forest algorithm achieved an area under the curve (AUC) of 0.816 and 0.809, respectively. In this study, we presented the ML model using demographics, vital signs, and lab data, promising results in predicting delayed bleeding risk in torso trauma patients. Our study also showed the possibility of an early warning system alerting ICU staff that trauma patients need re-evaluation or further survey.

Background Rib fractures are the most common thoracic injury in patients who sustained blunt trauma, and potentially life-threatening associated injuries are prevalent. Multi-disciplinary work-up is crucial to achieving a comprehensive understanding of these patients. The present study demonstrated the experience of an acute care surgery (ACS) model for rib fracture management from a single level I trauma center over 13 years. Methods Data from patients diagnosed with acute rib fractures from January 2008 to December 2020 were collected from the trauma registry of Chang Gung Memorial Hospital (CGMH). Information, including patient age, sex, injury mechanism, Abbreviated Injury Scale (AIS) in different anatomic regions, injury severity score (ISS), index admission department, intensive care unit (ICU) length of stay (LOS), total admission LOS, mortality, and other characteristics of multiple rib fracture, were analyzed. Patients who received surgical stabilization of rib fractures (SSRF) were analyzed separately, and basic demographics and clinical outcomes were compared between acute care and thoracic surgeons. Results A total of 5103 patients diagnosed with acute rib fracture were admitted via the emergency department (ED) of CGMH in the 13-year study period. The Department of Trauma and Emergency Surgery (TR) received the most patients (70.8%), and the Department of Cardiovascular and Thoracic Surgery (CTS) received only 3.1% of the total patients. SSRF was initiated in 2017, and TR performed fixation for 141 patients, while CTS operated for 16 patients. The basic demographics were similar between the two groups, and no significant differences were noted in the outcomes, including LOS, LCU LOS, length of indwelling chest tube, or complications. There was only one mortality in all SSRF patients, and the patient was from the CTS group. Conclusions Acute care surgeons provided good-quality care to rib fracture patients, whether SSRF or non-SSRF. Acute care surgeons also safely performed SSRF. Therefore, we propose that the ACS model may be an option for rib fracture management, depending on the deployment of staff in each institute.

(1) Background: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Serious extracranial injury (SEI) commonly coexists with sTBI after the high impact of trauma. Limited studies evaluate the influence of SEI on the prognosis of pediatric sTBI. We aimed to analyze SEI’s clinical characteristics and initial presentations and evaluate if SEI is predictive of higher in-hospital mortality in these sTBI children. (2) Methods: In this 11-year-observational cohort study, a total of 148 severe sTBI children were enrolled. We collected patients’ initial data in the emergency department, including gender, age, mechanism of injury, coexisting SEI, motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and intracranial Rotterdam computed tomography (CT) score of the first brain CT scan, as potential mortality predictors. (3) Results: Compared to sTBI children without SEI, children with SEI were older and more presented with initial hypotension and hypothermia; the initial lab showed more prolonged prothrombin time and a higher in-hospital mortality rate. Multivariate analysis showed that motor components of mGCS, fixed pupil reaction, prolonged prothrombin time, and higher Rotterdam CT score were independent predictors of in-hospital mortality in sTBI children. SEI was not an independent predictor of mortality. (4) Conclusions: sTBI children with SEI had significantly higher in-hospital mortality than those without. SEI was not an independent predictor of mortality in our study. Brain injury intensity and its presentations, including lower mGCS, fixed pupil reaction, higher Rotterdam CT score, and severe injury-induced systemic response, presented as initial prolonged prothrombin time, were independent predictors of in-hospital mortality in these sTBI children.

Accurate positioning in global navigation satellite system (GNSS)-denied environments, such as tunnels and underpasses, remains a challenge. Navigation systems for such environments need to strike a balance between price and precision. In this paper, we propose magnetic vehicular positioning (MVP), a navigation system that guides drivers in GNSS-denied environments. The key idea of MVP is to extract magnetic fingerprints from geomagnetic field anomalies. By comparing the measured magnetic field against a magnetic map, positioning can be achieved without GNSS signals. Our proposed matching algorithm allows MVP to provide 5.14 m positioning accuracy. We conducted large-scale real-road experiments for 36 months in two countries and 56 tunnels to demonstrate the effectiveness of the proposed system. Because MVP can be deployed on off-the-shelf smartphones, our approach makes accurate navigation in GNSS-denied environments affordable.

Dual Active (Full) Bridge (DAB), has the advantages of wide voltage operation range, zero voltage switching, and easier bidirectional control. However, the traditional single phase shift (SPS) control has the circulating current problem which will cause high conduction and switching loss, especially under different transfer ratios between input and output operating conditions. Many modulation methods are proposed to solve the aforementioned problem. This paper adopts the dual phase shift (DPS) with a minimum peak current control algorithm to reduce the conduction and switching loss. Eventually, a 10 kW DC-DC converter is implemented with a digital controller and has been evaluated. The output voltage range of this converter is from 400 V to 500 V and input voltage is 750 V. According to the test result, the peak efficiency is up to 97.6% when the output voltage is 500 V, 60% load, moreover, when converter operating at 400 V output voltage and 10% load, the efficiency is 94%.

The prognostic role of the preoperative lymphocyte-to-monocyte ratio (LMR) in patients with gastric adenocarcinoma (GC) remains unclear. The aim of this study was to explore the prognostic potential of the preoperative LMR in patients with resectable GC.The medical records of 926 consecutive patients with resectable GC between 2005 and 2010 were retrospectively reviewed and analyzed. Patients were stratified into two groups based on the preoperative LMR with a cutoff value of 4.8 (group 1: LMR ≤ 4.8; group 2: LMR 4.8). Clinicopathologic factors potentially affecting patient outcomes were collected prospectively and analyzed.Compared to group 2, in group 1, there was a higher percentage of men, patients aged48 y, total gastrectomy, tumor size4.8 cm, T4 lesions, N3 disease, metastatic tumors, advanced stage, ratio of metastatic to examined lymph nodes0.18, R1 resection, and occurrence of vascular or lymphatic invasion. Group 1 also had a higher 30-d surgical mortality rate (groups 1 versus 2 at 2.9% versus 0.5%; P = 0.006) and lower 3-y and 5-y overall survival (53.6% versus 71.9% and 46.4% versus 63.3%, respectively; P 0.0001). Multivariate analysis showed that preoperative low LMR was an unfavorable prognostic factor for resectable GC.Patients with lower LMR had more aggressive tumor behavior, higher surgical mortality rates, and worse long-term survival. The preoperative LMR may serve as an independent prognostic factor for prediction of surgical outcomes and for assisting clinicians in determining future treatment plans.

[Purpose] This study aimed to determine the effectiveness of joystick-controlled video console games in enhancing subjects’ ability to control power wheelchairs. [Subjects and Methods] Twenty healthy young adults without prior experience of driving power wheelchairs were recruited. Four commercially available video games were used as training programs to practice joystick control in catching falling objects, crossing a river, tracing the route while floating on a river, and navigating through a garden maze. An indoor power wheelchair driving test, including straight lines, and right and left turns, was completed before and after the video game practice, during which electromyographic signals of the upper limbs were recorded. The paired t-test was used to compare the differences in driving performance and muscle activities before and after the intervention. [Results] Following the video game intervention, participants took significantly less time to complete the course, with less lateral deviation when turning the indoor power wheelchair. However, muscle activation in the upper limbs was not significantly affected. [Conclusion] This study demonstrates the feasibility of using joystick-controlled commercial video games to train individuals in the control of indoor power wheelchairs.

The immobilization antigens (i-antigens) of Ichthyophthirius multifiliis are potential vaccine candidates for the prevention of 'white spot' disease in freshwater fish. These antigens vary with respect to antigenicity and molecular mass, and at least five i-antigen serotypes have been identified among parasite isolates thus far. In previous studies, the gene and corresponding cDNA encoding a approximately 48 kDa i-antigen from parasite isolate G1 (serotype A), had been cloned and sequenced. We now report on the isolation of two new genes, designated IAG52A[G5] and IAG52B[G5], encoding approximately 52/55 kDa i-antigens from a parasite isolate representing a different serotype, namely, D. Based on their deduced sequences, the approximately 52/55 kDa gene products have the same structural features as the 48 kDa protein including hydrophobic N- and C-termini, periodic cysteine residues with the potential for metal binding, and tandemly repetitive amino acid sequence domains that span their length. Nevertheless, the products of these genes vary in their tandem repeat copy number, and share only approximately 50% homology overall. When expressed in heterologous systems, the products of the newly described genes react strongly with monospecific polyclonal antisera against the i-antigens of serotype D and are clearly i-antigens. It would nevertheless appear that mRNA transcripts from the two genes are present at widely different levels within parasites themselves. Analysis at the protein level using 2-D SDS-PAGE would further suggest that multiple i-antigens are expressed within the same serotype at any given time.